Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Verona, Italy.
Istituto di Ricovero e Cura a Carattere Scientifico San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.
J Allergy Clin Immunol. 2014 Jan;133(1):104-10.e1-4. doi: 10.1016/j.jaci.2013.03.040. Epub 2013 May 15.
Evidence on the longitudinal association of airway responsiveness with respiratory diseases is scarce. The best indicator of responsiveness is still undetermined.
We investigated the association of airway responsiveness with the incidence of asthma, chronic obstructive pulmonary disease (COPD), and allergic rhinitis.
We studied 3851 subjects who underwent spirometry and methacholine challenge tests both at baseline (1991-1993), when they were 20 to 44 years old, and at follow-up (1999-2002) in the European Community Respiratory Health Survey. Airway responsiveness was defined based on the methacholine dose-response slope on both occasions. Incidence rate ratios for the association of airway responsiveness with disease occurrence were computed by using Poisson regression.
With respect to reference (slope of the fourth quintile or greater), subjects with the greatest degree of airway responsiveness (slope less than the first quintile) showed the greatest risk of developing asthma, COPD, and allergic rhinitis (incidence rate ratios of 10.82, 5.53, and 4.84, respectively; all P < .01). A low slope predicted disease occurrence, even in subjects who did not reach a 20% decrease in FEV1 at the cumulative dose of 1 mg of methacholine (PD20 >1 mg). A decrease in slope over time was an independent predictor of disease risk.
Airway responsiveness predicted new-onset asthma, COPD, and allergic rhinitis. Our study supports the use of a continuous noncensored indicator of airway responsiveness, such as the slope of the methacholine dose-response curve, in clinical practice and research because it showed clear advantages over PD20.
气道反应性与呼吸系统疾病之间的纵向关联的证据有限。气道反应性的最佳指标仍未确定。
我们研究了气道反应性与哮喘、慢性阻塞性肺疾病(COPD)和过敏性鼻炎发病率的关系。
我们研究了 3851 名受试者,他们在基线时(1991-1993 年)、20 至 44 岁时以及随访时(1999-2002 年)接受了肺量计和乙酰甲胆碱挑战测试,在这两个时间点都基于乙酰甲胆碱剂量-反应斜率来定义气道反应性。使用泊松回归计算气道反应性与疾病发生之间关联的发病率比值比。
与参考(第四五分位或更大斜率)相比,气道反应性最大的受试者(斜率小于第一五分位)发展为哮喘、COPD 和过敏性鼻炎的风险最高(发病率比值比分别为 10.82、5.53 和 4.84;均 P<.01)。即使在累积剂量达到 1 毫克的乙酰甲胆碱时(PD20>1 毫克)未达到 FEV1 下降 20%的患者中,低斜率也预测了疾病的发生。斜率随时间的下降是疾病风险的独立预测因子。
气道反应性预测了新发病例的哮喘、COPD 和过敏性鼻炎。我们的研究支持在临床实践和研究中使用连续的非截尾气道反应性指标,如乙酰甲胆碱剂量-反应曲线的斜率,因为它比 PD20 具有明显优势。